Identifying sleep disturbance- and fatigue-related factors of poor health-related quality of life in patients with advanced ovarian cancer

Abstract Background Given that sleep disturbance and fatigue are pervasive among patients with advanced ovarian cancer (OC) and associated with poor health-related quality of life (HRQoL), several patient-reported outcome measures have been used to assess symptom burden. However, it remains unclear which patient-reported topic domains are most important to HRQoL for advanced OC patients. This study aimed to assess the domains of sleep disturbance and fatigue associated with poor HRQoL among patients with advanced OC across their treatment trajectory. Methodology We conducted an online survey with adults diagnosed with Stage III or IV OC in the last three years. Patients reported clinical and sociodemographic characteristics, sleep disturbance and fatigue levels using Patient-Reported Outcomes Measurement Information System (PROMIS) short forms, and HRQoL using the CDC Healthy Days measure. Hierarchical regression models were used to assess how sleep disturbance and fatigue short-form items predicted poor HRQoL, specifically the number of days where poor health interfered with daily life and poor physical and mental health days (unhealthy days) in the past month, compared to clinical (time since treatment, treatments received, metastatic status) and sociodemographic (age, gender, marital status, employment) factors. Results Among the 200 participants diagnosed with advanced OC (71.50% Stage III, 28.50% Stage IV; 33.50% receiving chemotherapy, 44.00% receiving maintenance therapy), sleep disturbance and fatigue were significantly associated with poor HRQoL. Compared to clinical and sociodemographic variables, sleep disturbance levels explained 17.00% more variance in the number of unhealthy days in the past month; fatigue levels explained 30.00% more variance in the number of unhealthy days. Among short form items, having difficulty falling asleep (β = 0.17, p = .03), fatigue interfering with physical function (β = 0.24, p < .01), and feeling run-down (β = 0.35, p < .01) were the strongest predictors of poor HRQoL. Conclusion Patients with advanced OC reported significantly elevated levels of sleep disturbance and fatigue, which were associated with poor physical and mental health. Findings highlight the importance of screening for difficulty falling asleep, interference with physical function, and feeling run-down to connect patients with supportive care that may improve their HRQoL during and after treatment.